Provider Demographics
NPI:1801514492
Name:BLACKBURN, FELICIA (NP)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:BLACKBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29507 MEADOW CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BROOKSHIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77423-1988
Mailing Address - Country:US
Mailing Address - Phone:832-530-6722
Mailing Address - Fax:
Practice Address - Street 1:24124 CINCO VILLAGE CENTER BLVD
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-8396
Practice Address - Country:US
Practice Address - Phone:281-688-5337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1068234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily